‫ﺇﺨﻼء ﻁﺭﻑ‬

Clearance form

‫ﻋﻠﻰ ﻜل ﺍﻟﻤﺩﺭﺍء ﺍﻟﻤﻌﻨﻴﻴﻥ ﺍﻟﺘﻭﻗﻴﻊ ﻋﻠﻰ ﻁﻠﺏ ﺇﺨﻼء ﻁﺭﻑ ﺍﻟﻤﻭﻅﻑ ﻋﻨﺩ ﻤﻐﺎﺩﺭﺓ ﺍﻟﺸﺭﻜﺔ ﺴﻭﺍءً ﺇﺠﺎﺯﺓ ﺃﻭ ﺇﻨﻬﺎء ﺨﺩﻤﺔ ﺒﻌﺩ ﺍﻟﺘﺄﻜﺩ ﻤﻥ ﻋﺩﻡ ﻭﺠﻭﺩ ﺃﻱ‬
‫ﻋﻬﺩﺓ ﺃﻭ ﻤﺘﻁﻠﺒﺎﺕ ﻟﻠﺸﺭﻜﺔ ﻋﻠﻰ ﺃﻥ ﺘﺴﺘﺜﻨﻰ ﺍﻟﻤﻁﺎﻟﺒﺎﺕ ﺍﻟﺨﺎﺼﺔ ﻭﺍﻟﺘﻲ ﺒﻴﻥ ﺍﻟﻤﻭﻅﻑ ﻭﺃﻱ ﺃﻁﺭﺍﻑ ﺃﺨﺭﻯ ﻭﻻ ﺘﺘﺤﻤل ﺍﻟﺸﺭﻜﺔ ﺃﻱ ﻤﺴﺌﻭﻟﻴﺔ ﻓﻲ ﻫﺫﺍ ﺍﻟﺸﺄﻥ‬
. ‫ﻤﺎ ﻟﻡ ﺘﻜﻭﻥ ﻗﺩ ﺘﻌﻬﺩﺕ ﺒﺫﻟﻙ ﻭﺒﺨﻁﺎﺒﺎﺕ ﻤﻜﺘﻭﺒﺔ‬
All concerned managers shall sign the employee release form when leaving the company either vacation or end
service after confirming that there are no requirements or any custody under the employees responsibility belongs to
company with exceptions of personal requirements between the employee and any other parties unless the company
is committed in writing to take responsibility.

Date: ‫ﻡ‬ / / :‫ﺍﻟﺘﺎﺭﻴﺦ‬

Employee Information ‫ﺒﻴﺎﻨﺎﺕ ﺍﻟﻤﻭﻅﻑ‬

.Name : : ‫ﺍﻻﺴﻡ‬
Emp.No : ‫ﺍﻟﺭﻗﻡ ﺍﻟﻭﻅﻴﻔﻲ‬
Dept.: : ‫ﺍﻹﺩﺍﺭﺓ‬
Job title: : ‫ﺍﻟﻭﻅﻴﻔﺔ‬ ‫ﻤﺴﻤﻰ‬
Vacation/End Service Data: : ‫ﺇﻨﻬﺎء ﺨﺩﻤﺔ‬/ ‫ﺘﺎﺭﻴﺦ ﺍﻹﺠﺎﺯﺓ‬

Emp. Signature: :‫ﺘﻭﻗﻴﻊ ﺍﻟﻤﻭﻅﻑ‬

Reasons if No release Signature Department

‫ﺍﻟﺴﺒﺏ ﻓﻲ ﺤﺎل ﺭﻓﺽ ﺇﺨﻼء ﺍﻟﻁﺭﻑ‬ ‫ﺍﻟﺘﻭﻗﻴﻊ‬ ‫ﺍﻹﺩﺍﺭﺓ‬
‫ﺇﺩﺍﺭﺓ ﺍﻟﻤﻭﻅﻑ‬
Employee Dept
‫ﺇﺩﺍﺭﺓ ﺘﻘﻨﻴﺔ ﺍﻟﺤﺎﺴﺏ ﺍﻵﻟﻲ‬
IT Dept
‫ﺇﺩﺍﺭﺓ ﺍﻟﻤﻭﺍﺩ‬
Material Department
‫ﺍﻟﻤﻭﺍﺭﺩ ﺍﻟﺒﺸﺭﻴﺔ ﻭﺍﻟﺸﺅﻭﻥ ﺍﻹﺩﺍﺭﻴﺔ‬
H.R Department
‫ﺍﻻﺩﺍﺭﺓ ﺍﻟﻤﺎﻟﻴﺔ‬
Financial Department

Form # qf-62-03-19 rev.a

Form # qf-62-03-19 rev.a